When Pamela Mahoney and Alex Tsigdinos were married, they never thought they would have trouble having a baby. But after 11 years and many fertility treatments, they are still only a family of two.
Frustrated and exhausted by expensive, drawn-out procedures that never worked, the couple have finally given up. Now the challenge is learning how to accept a life without children.
Ten percent of all couples have trouble conceiving, sometimes because of a physical problem and sometimes for unexplained reasons. But as reproductive technologies have advanced, many couples are being given help and hope.
For the Tsigdinoses, of Los Gatos, Calif., doctors were optimistic at every step. At 29, after two years of trying to become pregnant, Mrs. Tsigdinos learned she had small lesions on her uterus — a sign of early endometriosis, a condition marked by uncontrolled tissue growth in the uterus. The lesions were surgically removed, and doctors sent her home with every expectation that she would have no further trouble conceiving.
Time passed, and still no baby. Mr. Tsigdinos was tested, and the couple discovered that he suffered from varicocele, a blockage in blood flow to the penis that lowered his sperm count. Surgery corrected the problem. But two more years passed, and still nothing.
Over the next several years, the couple tried two cycles of in vitro fertilization and two rounds of artificial insemination, not to mention some nontraditional approaches, including acupuncture, herbal supplements and chiropractic treatment.
Time was becoming a demon: for women under 35, the pregnancy rate after I.V.F. is about 43 percent, but it drops to 4 percent for women over 42. Years of medical appointments, doctors’ bills and unattained dreams were taking their toll, too, straining the couple’s savings, their patience and their marriage.
Finally, Mrs. Tsigdinos recalled recently, they had had enough. “I turned 39, looked in the mirror and said, ‘How much longer can we do this?’ ” she said.
Two years ago, Mr. and Mrs. Tsigdinos made the difficult decision to end it: to stop the invasive procedures, to stop daily charting her basal body temperature to help determine when she was about to ovulate, to stop researching every new treatment — and to stop dreaming of having children.
Mrs. Tsigdinos knows what you’re thinking: What about adoption? But while the couple considered it, it did not seem right for them.
“It’s not a binary — you either have a child or adopt. It’s not that simple,” she said, recalling the struggles of friends who pursued adoptions.
It is unclear how many women are involuntarily childless. The stigma attached to infertility and living without children pressures many women to remain silent about their struggles, Mrs. Tsigdinos said, adding, “It’s not something you want to drop into conversation at a cocktail party.”
Almost two years later, Mrs. Tsigdinos, now 45, still tears up when she talks about it. “It’s not a linear process,” she said. “You accept that you’re going to do your best to move on, but there are those days when things just become overwhelming.”
Experts recommend that women wrestling with the decision to stop fertility treatments look at their loss as they would any other.
“The person has to go through a process of mourning for what this was going to be in their life and who they were going to be in this life,” said Mardy S. Ireland, a psychoanalyst from Berkeley, Calif., who specializes in childlessness.
Infertility treatment can be so all-consuming that many women keep trying long after the odds become prohibitive. Those who can accept the possibility that no treatment in the world will allow them to become pregnant may face the best chance of learning to accept a childless life.
“The ones with the most difficulty living with their reality are those who don’t make a decision,” Dr. Ireland said. Those who don’t, she added, will wake up one day to feel the choice to stop was taken away from them.
Still, women like Mrs. Tsigdinos often find themselves in tears at the sight of a new mother pushing a stroller, fighting anger toward friends who innocently invite them to baby showers, and arguing with their own parents, who have not accepted that they will never be grandparents.
Susan B. Slotnick, a board member of Resolve, a nonprofit infertility association, understands that pain. Eleven years ago, she too made the decision to stop fertility treatments and accept a childless life. “The pain never really goes away,” she said. “But like a chronic back pain, you learn to deal with it.”
That dull ache unites women at all stages of their quest for children, and a growing online community helps them cope with the many facets of infertility. Mrs. Tsigdinos, a marketer for a venture capital company, began her own blog about the flip side of successful treatment, at www.Coming2Terms.com, when she could not find resources to help her cope with the decision to stop infertility treatments.
After her years of focusing on becoming pregnant, Mrs. Tsigdinos’s passion is now connecting with other women in her situation. She writes about the everyday things that remind her of her childlessness, but also of what she had to deal with along the way: how to know when to stop treatment, how to deal with prying friends and relatives, how to accept a life without the expected routine of children’s books, recitals and graduation ceremonies. The women and the few men who comment on her blog may not always agree with her choices, but they all sympathize and help her feel less alone.
Infertility might have been the underlying current of Mrs. Tsigdinos’s life. But she is adamant that it has not blinded her to what she does have.
“I have to say I am one of the luckiest women on the planet because, if nothing else, I have the most patient husband,” she said. “Because it’s just the two of us, we spend a lot of time making sure each other is happy.”